Operative therapy in disease progression and local recurrence of renal cell carcinoma

When local recurrence or distant metastasis occurs, the question arises as to which therapeutic concept should be applied. In contrast to the data on systemic immunotherapy, there are no systematic studies on surgical management of metastasis. Local recurrence (a rare condition) is frequently resected, whereby a prolongation of life can be achieved in individual cases. The complete surgical resection of pulmonary metastases has been shown, in a number of studies, to achieve a survival rate of 5 years in up to 44% of the cases. There are only few data regarding resection of osseous metastases; although in this respect some studies have reported an average survival rate of 34 months, the indication for this condition has, up to now, usually been seen as palliative. The prognosis of liver or brain metastasis is unfavorable; the survival rates achieved with the help of surgical procedures are scarcely higher than those resulting from the spontaneous progression of metastatic renal carcinoma (12 months). Thus, there is an urgent need for further studies in order to define the indication for the surgical management of metastasis.